| National Provider Identifier [NPI]: | 1154393841 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | GORDON |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2055 NORMANDIE DR |
| Street Address 2 Of The Provider | 108 |
| City Of The Provider | MONTGOMERY |
| Zip Code Of The Provider | 361112732 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 208 |
| Number Of Services | 7927 |
| Number Of Medicare Beneficiaries | 5138 |
| Total Submitted Charge Amount | 767039.91 |
| Total Medicare Allowed Amount | 229730.72 |
| Total Medicare Payment Amount | 169750.92 |
| Total Medicare Standardized Payment Amount | 182297.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 208 |
| Number Of Medical Services | 7927 |
| Number Of Medicare Beneficiaries With Medical Services | 5138 |
| Total Medical Submitted Charge Amount | 767039.91 |
| Total Medical Medicare Allowed Amount | 229730.72 |
| Total Medical Medicare Payment Amount | 169750.92 |
| Total Medical Medicare Standardized Payment Amount | 182297.07 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1239 |
| Number Of Beneficiaries Age 65 to 74 | 1847 |
| Number Of Beneficiaries Age 75 to 84 | 1387 |
| Number Of Beneficiaries Age Greater 84 | 665 |
| Number Of Female Beneficiaries | 3170 |
| Number Of Male Beneficiaries | 1968 |
| Number Of Non Hispanic White Beneficiaries | 3350 |
| Number Of Black or African American Beneficiaries | 1722 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3515 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1623 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.5802 |